Individual
BEVERLY MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1841 MADORA AVE, DOUGLAS, WY 82633-3057
(307) 358-2792
(307) 258-5329
Mailing address
1841 MADORA AVE, DOUGLAS, WY 82633-3057
(307) 358-2792
(307) 258-5329
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC
WY
101YM0800X
Mental Health Counselor
Primary
LPC
WY
Other
Enumeration date
10/22/2008
Last updated
10/22/2008
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